Remote Coordinator for Utilization Management

Job Title: Utilization Management Coordinator - Remote

Job Overview

As a vital member of our clinical team, the Utilization Management (UM) Coordinator will provide essential support in handling administrative and non-clinical tasks related to the processing of UM prior authorizations and appeals. This position is designed for those who thrive in a dynamic and fast-paced environment, offering significant opportunities for professional growth while contributing to our mission of enhancing the quality of life for the communities we serve.

Key Responsibilities
• Monitor and manage incoming faxes
• Input UM authorization review requests into our proprietary UM platform using ICD-10 and HCPCS codes
• Verify eligibility and claims history within our claims system
• Ensure comprehensive documentation accompanies all authorization requests
• Communicate with requesting providers to gather necessary medical records or documentation
• Prepare and disseminate correspondence, including member and provider notifications
• Execute verbal notifications and maintain documentation in the authorization platform
• Initiate appeal processes and collaborate with UM Nurses for completion
• Adhere to internal and regulatory deadlines for UM processes
• Handle inquiries from the call center and other internal and external sources
• Perform additional tasks as assigned by the UM Director

Required Skills
• Exceptional organizational skills with the ability to adapt to rapid changes
• Team-oriented mindset with a self-motivated and positive attitude
• Proficient knowledge of ICD-10, HCPCS codes, and medical terminology
• Strong computer skills, particularly in Word, Outlook, and relevant software applications
• Effective written and verbal communication abilities
• Capability to collect data, establish facts, and derive valid conclusions
• Experience with DMEPOS is desirable
• Familiarity with Medicare and Medicaid is advantageous

Qualifications
• Minimum of 1 year of experience in a UM Coordinator role within a managed care payer environment is preferred
• Proven ability to prioritize and manage multiple tasks efficiently

Career Growth Opportunities

In your first six months, you will gain proficiency in verbal notifications, authorization systems such as Essette and Salesforce, and develop a thorough understanding of UM team expectations. Over the first year, you will deepen your knowledge of ICD-10 and HCPCS codes while meeting essential timelines.

Company Culture And Values

Established in 2005, our organization is a prominent network management company specializing in Orthotics, Prosthetics, and Durable Medical Equipment. We aim to transform access to in-home healthcare, positively impacting the communities we serve. Our culture emphasizes collaboration and teamwork, guided by our core values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We seek motivated and dedicated individuals eager to join our mission-driven team.

Compensation And Benefits
• Competitive hourly wage of $19
• Comprehensive benefits package including Medical, Dental, Vision, Life Insurance, and Paid Time Off (PTO)
• Retirement plan with company match
• Paid Parental Leave and Sick Time
• Company-sponsored events and health and wellness programs
• Remote work flexibility available for eligible candidates.

Employment Type: Full-Time

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